New SHA e-procurement system will enhance transparency - PS Kimtai

The Social Health Authority (SHA) is set to transform how hospitals contract and process medical claims by introducing a new electronic procurement system.

This shift aims to eliminate fraud and inefficiencies associated with the previous manual contracting process.

Medical Services PS Harry Kimtai noted the benefits of the e-system during a recent statement.

"With the e-system, we will streamline operations, reduce corruption, and enhance transparency in healthcare," he said on Tuesday.

Previously, employees of the National Health Insurance Fund (NHIF) were responsible for manually licensing medical centres and processing claims.

This system often led to favouritism and manipulation in claims approvals, resulting in delays and resource strains, particularly for critical services like dialysis and oncology.

Kimtai highlighted the challenges faced by a hospital in Turkana County, which had to manually send claims to Nairobi for processing.

"By the time you start processing claims, much time is gone, and hospitals have run out of patience. They are not getting returns on the money they have invested," he explained.

The new electronic system will remove the need for NHIF staff to conduct in-person inspections and data entry, which previously opened doors to manipulation.

"Some hospitals were paid for services they never offered," Kimtai noted.

Regulating contracts

With the e-system, SHA will take on the responsibility of regulating contracts and ensuring that hospitals and practitioners are appropriately licensed and approved.

The Ministry of Health has mandated that hospitals register in the new system by Friday.

"By digitising the contracting, SHA promises a more efficient and transparent system that minimizes human intervention in claims approvals and hospital contracts," Kimtai stated.

Hospitals will now be able to upload claims directly into the system, which will process the data automatically and trigger payments based on pre-set conditions.

"We have directed the SHA to settle claims within 90 days. Those investing in the business should be sure of the returns so that they can grow," the PS added.

Recent audits uncovered four hospitals that allegedly received hundreds of millions of shillings through fictitious NHIF claims.

The Auditor-General reported that these hospitals colluded with NHIF staff and cardholders to falsify information, pocketing Sh700 million during the Financial Year 2022- 2023.

Some patients supposedly admitted to these hospitals were found to be at their workplaces at the time.

However, since the transition from NHIF to SHA, hospitals have faced difficulties accessing the SHA portal, leading to challenges in submitting claims.

This slow adoption of the new system has created a backlog of claims and frustrated hospital staff.

The PS Kimtai assured that claims lodged after the transition would be addressed as the system becomes fully operational.